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1st April – 17th May 2019

LIAQUAT NATIONAL HOSPITAL

& MEDICAL COLLEGE

GASTROINTESTINAL TRACT & LIVER MODULE-I

SECOND YEAR MBBS SEMESTER 4

STUDY GUIDE

2ND YEAR MBBS, SEMESTER 4 GIT & LIVER I MODULE LIAQUAT NATIONAL MEDICAL COLLEGE

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STUDY GUIDE FOR GASTROINTESTINAL TRACT & LIVER MODULE-I

S.No

CONTENTS Page No

1 Overview 3 2 Introduction to Study Guide 4

3 Learning Methodologies 5

4 Module 1: GIT & Liver-I 7

4.1 Importance of GIT & Liver 7

4.2 Objectives and Learning strategies 8 5 Learning Resources 21

* 6 Assessment Methods 23 7 Modular Examination Rules and Regulations (LNMC) 25

8 Schedule 266


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Module name: Gastro-Intestinal Tract (GIT) & Liver-I

Semester: Four Year: Two Duration: 6 weeks (April - May 2019)

Timetable hours: Interactive Lectures, Case-Based Learning (CBL), Self-Study, Practicals in

Laboratory, Skills, Demonstrations

Credit hours: 6 credit hours in theory and 3 credit hours in practical

MODULE INTEGRATED COMMITTEE

DEPARTMENTS’ & RESOURCE PERSONS’ FACILITATING LEARNING

MODULE COORDINATOR: • Prof. Tabassum Zehra (Pharmacology)

CO-COORDINATORS: • Prof. Nighat Huda (DHCE)

BASIC HEALTH SCIENCES CLINICAL AND ANCILLARY DEPARTMENTS

ANATOMY • Professor Zia-ul-Islam

RESEARCH & SKILLS DEVELOPMENT CENTER • Dr Kahkashan Tahir

BIOCHEMISTRY • Professor Naheed Qadir

RADIOLOGY • Dr. Muhammad Ayub Mansoor • Dr. Roomi Mahmud

COMMUNITY MEDICINE • Professor Rafiq Soomro

MICROBIOLOGY • Professor Syed Khursheed H. Hashmi

PATHOLOGY • Professor Naveen Faridi

PHARMACOLOGY • Professor Nazir Ahmad Solangi • Professor Tabassum Zehra

PHYSIOLOGY • Professor Syed Hafeezul Hassan

DEPARTMENT of HEALTH CARE EDUCATION Professor Nighat Huda Dr. Sobia Ali Dr. Afifa Tabassum Dr. Mehnaz Umair Dr. Muhammad Suleman

LNH&MC MANAGEMENT

Professor Karimullah Makki, Principal LNH&MC Dr. Shaheena Akbani, Director A.A & R.T LNH&MC

STUDY GUIDE COMPILED BY: Dr. Mehnaz Umair, Department of Health Care Education


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INTRODUCTION

WHAT IS A STUDY GUIDE?

It is an aid to:

• Inform students how student learning program of the semester-wise module has been

organized

• Help students organize and manage their studies throughout the module

• Guide students on assessment methods, rules and regulations

THE STUDY GUIDE:

• Communicates information on organization and management of the module.

This will help the student to contact the right person in case of any difficulty.

• Defines the objectives which are expected to be achieved at the end of the module.

• Identifies the learning strategies such as Interactive Lectures, small group teachings,

clinical skills, demonstration, tutorial and case based learning that will be implemented

to achieve the module objectives.

• Provides a list of learning resources such as books, computer assisted learning programs,

web- links, journals, for students to consult in order to maximize their learning.

• Highlights information on the contribution of continuous and semester examinations on the

student’s overall performance.

• Includes information on the assessment methods that will be held to determine every student’s

achievement of objectives.

• Focuses on information pertaining to examination policy, rules and regulations.

CURRICULUM FRAMEWORK Students will experience integrated curriculum in 4th semesters at LNMC in accordance with the JSMU

guidelines and most recent developments that have an impact on individual health.

INTEGRATED CURRICULUM comprises of system-based modules such as GIT & Liver-I, Renal & Excretory

System-I and Reproduction-I which links basic science knowledge to clinical problems. Integrated

teaching means that subjects are presented as a meaningful whole. Students will be able to have

better understanding of basic sciences when they repeatedly learn in relation to clinical examples.

Case-based discussions, computer-based assignments, early exposure to clinics, wards, and skills

acquisition in skills lab and physiotherapy department are characteristics of integrated teaching program.


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LEARNING METHODOLOGIES

The following teaching / learning methods are used to promote better understanding:

• Interactive Lectures

• Hospital / Clinic visits • Small Group Discussion

• Case- Based Learning

• Practicals

• Skills session

• Self-study

INTERACTIVE LECTURES

In large group, the Interactive Lecturer introduces a topic or common clinical conditions and explains the

underlying phenomena through questions, pictures, videos of patients’ interviews, exercises, etc.

Students are actively involved in the learning process.

HOSPITAL VISITS: In small groups, students observe patients with signs and symptoms in hospital or

clinical settings. This helps students to relate knowledge of basic and clinical sciences of the relevant

module.


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SMALL GROUP DISCUSSION (SGD): This format helps students to clarify concepts acquire skills or

attitudes. Sessions are structured with the help of specific exercises such as patient case, interviews or

discussion topics. Students exchange opinions and apply knowledge gained from Interactive Lectures,

tutorials and self study. The facilitator role is to ask probing questions, summarize, or rephrase to help

clarify concepts.

CASE- BASED LEARNING: A small group discussion format where learning is focused around a series of

questions based on a clinical scenario. Students’ discuss and answer the questions applying relevant

knowledge gained in clinical and basic health sciences during the module.

PRACTICAL: Basic science practicals related to anatomy, biochemistry, pathology, pharmacology and

physiology are scheduled for student learning.

SKILLS SESSION: Skills relevant to respective module are observed and practiced where applicable in

skills laboratory or Department of Physiotherapy.

SELF STUDY: Students’ assume responsibilities of their own learning through individual study, sharing and

discussing with peers, seeking information from Learning Resource Center, teachers and resource

persons within and outside the college. Students can utilize the time within the college scheduled hours

of self-study.


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SEMESTER 4 MODULE 1: GIT & LIVER

INTRODUCTION

In this module, medical students will learn in detail the normal structure, function and diseases of GI Tract

and hepatobiliary system. From Pakistan’s context, the prevalence and significance of GIT and liver illnesses

can be judged from the total days that adults and children who are affected remain absent from work or

schools; number of admissions to hospitals; and number of surgical procedures performed.

Children and adults present to general practice, or hospitals with signs and symptoms of some of very

common illnesses related to GIT & Liver including vomiting, chronic diarrhea, constipation, peptic ulcers,

enteric fever, malnutrition, jaundice etc. This module will provide students opportunities to understand the

basis of these illnesses including the mechanism involved in the development of these pathologies and

integrate basic medical science knowledge to clinical problem-solving.

Students will identify how GI structure (Embryology, Microscopic Anatomy and Gross Anatomy) integrates

with function (physiologic mechanisms of GI motility, digestion and absorption, and liver and pancreatic

function). During the module, students will acquire a wider, more generally applicable knowledge of

immunology, metabolism, infectious disease and pathology related to the GI system. Therefore, the overall

objective of this course is to provide an integrative understanding of the structure and functions of the

gastrointestinal tract.


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COURSE OBJECTIVES AND STRATEGIES

At the end of the module the students will be able to:

TOPICS & OBJECTIVES FACULTY LEARNING

STRATEGIES

1. Introduction of GIT

a) Classify the nutrients b) Describe effects of nutrient deficiency on health c) Explain control measures and prevention of nutrient

deficiency d) Classify macro and micronutrients e) Describe the role of micronutrients in body

metabolism f) List diseases caused by micronutrient deficiency g) Explain control measures and prevention of

micronutrient deficiency h) Define balanced diet i) Explain energy value and bioavailability of nutrients j) Describe composition of macronutrient in balanced

diet k) Calculate energy value from macronutrient

Community Medicine

Small Group Discussion

l) Discuss the abdominal quadrants with their contents and surface landmarks of the abdomen

Anatomy Tutorial

m) Discuss the characteristics of gastrointestinal wall n) Explain functional types of movements in GIT o) Describe gastrointestinal blood flow briefly

Physiology Interactive

Lecture/Small group discussion

2. Control of GIT

a) Describe autonomic nervous system b) Explain Myenteric and Meissner’s plexus c) List GIT hormones and their role in digestive process d) Describe GIT reflexes



3. Radiological assessment of GIT

a) Identify various parts of normal GIT on plain X-ray Radiology Interactive Lecture

4. Mastication and salivary secretions

a) Describe the mastication reflex b) Describe phases of deglutition c) Explain lower esophageal tone and motility

disorders

Physiology

Practical

d) List the salivary glands e) Discuss regulation of secretion of saliva (stimuli and

control)

Interactive Lecture/Small group

leaning

f) Discuss the salivary composition and functions Interactive Lecture


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5. Development of foregut, midgut and hindgut & congenital anomalies

a) Explain the process of development of GIT and divisions of primitive gut

b) Describe the derivatives of foregut , midgut & hindgut

c) Describe the development of : i. Esophagus ii. Stomach iii. Lesser & greater sac iv. Small and large intestine d) Discuss the common congenital anomalies

involving foregut: i. esophageal atresia/stenosis ii. congenital hypertrophic pyloric stenosis iii. duodenal atresia/ stenosis iv. accessory spleen e) Discuss the common congenital anomalies

involving midgut & hindgut i. congenital omphalocele ii. Gastroschisis iii. umbilical hernia iv. intestinal atresia/stenosis v. malrotationof gut vi. ileal diverticulum vii. intestinal duplication viii. Hirchsprung's disease ix. rectal atresia x. imperforate anus and anal stenosis f) Describe the development of liver, biliary apparatus

& pancreas and their congenital anomalies i. extrahepatic biliary atresia ii. annular pancreas iii. accessory pancreatic tissue g) Discuss the molecular regulation of Liver & Pancreas

development

Anatomy Interactive


h) Describe the following congenital anomalies of GIT:

i. Atresia ii. Fistulae iii. Diaphragmatic hernia iv. Omphalocele v. Gastroschisis vi. Ectopia vii. Meckel diverticulum viii. Congenital hypertrophic pyloric stenosis ix. Hirschsprung disease

Pathology Interactive Lecture


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6. Peritoneal cavity

a) Explain the layers, folds, recesses and compartments of peritoneum with their clinical importance

b) Discuss the extent of peritoneum, peritoneal cavity and reflections

c) Explain the boundaries of greater & lesser sac

Anatomy Interactive Lecture

7. Smooth muscles a) Discuss the functions of smooth muscles and their

electric properties b) Explain smooth muscle contraction mechanism c) Differentiate between smooth and skeletal muscles d) Describe genesis of BER and its role in GI motility



8. Esophagus and Stomach

a) Demonstrate the microscopic features of esophagus and stomach

b) Explain the gross anatomy of abdominal esophagus with its peritoneal & visceral relations, neurovascular supply , lymphatic drainage and clinical importance

Anatomy


discussion

c) Explain the gross anatomy of stomach with its peritoneal & visceral relations, neurovascular supply, lymphatic drainage and clinical importance

Small group discussion

d) Describe motor functions of stomach e) Explain regulation of stomach emptying f) Describe the composition, function and regulation

of gastric secretions Physiology


discussion

g) Discuss the causes and mechanism triggering vomiting

Pharmacology Interactive Lecture h) Discuss classification, mechanism of action, pharmacokinetics and adverse effects of antiemetic and prokinetic drugs

i) Classify esophagitis based on etiology j) Explain esophageal obstruction, varices and

achalasia

Pathology

Interactive Lecture

k) Explain the Barret esophagitis (risk factors, pathogenesis, morphology)


l) Describe acute and chronic gastritis with emphasis on H. Pylori gastritis and autoimmune gastritis

Interactive Lecture

m) Define peptic ulcer n) Discuss its pathogenesis and relation to H. Pylori

infection Interactive Lecture

o) Perform abdominal examination Skills Lab Small group discussion


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9. Pancreas

a) Explain the gross anatomical features of pancreas with its neurovascular supply, peritoneal relations and clinical importance Anatomy


b) Demonstrate the microscopic features of pancreas Practical

c) Discuss the composition, function and regulation of pancreatic secretion



d) Describe the non tumorous condition of pancreas (congenital anomalies, acute pancreatitis, non-neoplastic cysts)

Pathology Interactive Lecture

e) Discuss the risk factors for acid peptic disease f) Classify drugs used for treatment of acid peptic

disease g) Discuss the mechanism of action, pharmacokinetics,

therapeutic uses, adverse effects and drug interaction of H2 receptor antagonist

Pharmacology

Interactive Lecture

h) Discuss the mechanism of action, pharmacokinetics, therapeutic uses, adverse effects and drug interaction of proton pump inhibitor

Interactive Lecture

i) Discuss the mechanism of action, pharmacokinetics, therapeutic uses, adverse effects and drug interaction of mucosal protective agents such as Sucralfate, colloidal Bismuth compounds and prostaglandins

Interactive Lecture

j) Explain the mechanism of action, pharmacokinetics, therapeutic uses and adverse effects of Antacids

Interactive Lecture

k) Discuss the antimicrobial drugs used in the treatment of H. Pylori infection

Interactive Lecture

10. Small and large intestine

a) Demonstrate the microscopic features of small and large intestine

Anatomy

Practical

b) Differentiate between the parts of small and large intestine on the basis of anatomical features with neurovascular supply and lymphatic drainage

c) List the clinical conditions related to small & large intestine like volvulus and intussusception


d) List different enzymes secretions of small and large intestines

e) Describe regulation of different enzymes secretions of small and large intestines

Physiology

Interactive Lecture

f) Describe segmentation, peristalsis, mass movement and defecation reflex

g) Describe effects of autonomic system in modulating intestinal motility


discussion

h) Explain vomiting reflex and its causes Small group discussion


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i) Discuss malabsorption diseases (cystic fibrosis, celiac disease, environmental enteropathy, autoimmune enteropathy, lactase deficiency)

j) Discuss pathogenesis, risk factors, morphology and clinical features of celiac disesase

k) List causes of malabsorption and diarrhea Pathology


l) Discuss the inflammatory bowel diseases

m) Differentiate between ulcerative colitis and Crohn’s disease with risk factors, pathogenesis, morphology, clinical features and diagnosis

n) Explain irritable bowel disease

Interactive Lecture

o) Classify anti-diarrhreal drugs with their pharmacokinetics and clinical uses

Pharmacology Interactive


p) List signs and symptoms of enteric fever q) Discuss investigation and diagnosis of enteric fever r) Discuss role of immunization in prevention of enteric

fever s) Describe the epidemiology and prevention of

enteric/typhoid fever

Community Medicine

Interactive Lecture

t) Discuss the clinical importance of appendix and its neurovascular supply

Anatomy Interactive Lecture

11. Rectum & anal canal

a) Demonstrate the microscopic features of rectum and anal canal

Anatomy

Practical

b) Discuss the structure, neurovascular supply and clinical importance of rectum


c) Discuss the structure, neurovascular supply and clinical importance of anorectal junction and anal canal


d) Discuss the defecation reflex and its regulation Physiology


discussion

e) Differentiate between laxatives and purgatives based on their classification, mechanism of action, pharmacokinetics, therapeutic uses and adverse effects

Pharmacology Interactive Lecture

12. Liver & Hepatic portal system

a) Demonstrate the microscopic features of liver parenchyma with general concepts of hepatic lobule, portal lobule and hepatic acinus

b) Describe the microscopic structure of gall bladder c) Explain the histological features of exocrine part of

pancreas Anatomy

Practical

d) Describe the gross features, neurovascular supply and clinical correlation of liver, gall bladder and extra-hepatic biliary apparatus



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e) Explain the venous drainage of organs of GIT, hepatic portal system, its tributaries and sites of porto-systemic anastomosis with its clinical importance

Interactive Lecture

f) Discuss clinical features investigations of hepatic diseases

Pathology Interactive


g) Recognize the patterns of hepatic injury, cholestasis, jaundice and portal hypertension, cirrhosis and liver failure

h) List the causes of circulatory diseases of liver

i) List the hepatic diseases associated with pregnancy

j) Enumerate viral and other infectious causes of hepatitis

Microbiology ? k) Discuss acute and chronic hepatitis, their causes,

clinical features and lab values

l) Classify Hepatitis m) Describe signs and symptoms of Hepatitis A, B, C

and E n) Describe host, agent and environment of Hepatitis

A,B,C and E o) Explain control measures and prevention of

Hepatitis A,B,C and E p) Discuss Hepatitis control program of Pakistan

Community Medicine

Interactive Lecture

q) Discuss the clinical anatomy of spleen Anatomy Small group discussion

13. Gall bladder and biliary tract

a) Describe the gross features, neurovascular supply and clinical importance of gall bladder and extra-hepatic biliary apparatus

Anatomy Small group discussion

b) Discuss the microscopic features of gall bladder

Practical

c) Describe composition of bile and its regulation d) Explain conjugation and secretion of bile salts e) Explain role of bile acids in fats emulsification f) Describe enterohepatic circulation of bile salts

Physiology Interactive Lecture

14. Anterior and posterior abdominal wall

a) Describe the fascia, muscles and neurovascular supply of anterior and posterior abdominal wall

Anatomy Small group discussion

b) Explain formation of rectus sheath with its contents

c) Discuss the features of lumbar vertebrae

d) Discuss the anatomical features and clinical importance of inguinal canal

e) Differentiate between different types of abdominal and inguinal hernia


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15. Blood supply, nerve supply, lymphatics and surface anatomy of abdomen

a) Describe the paired and unpaired branches of abdominal aorta and their supply

Anatomy


b) Discuss the formation, extent, course and tributaries of Inferior vena cava


c) List the branches of lumbosacral plexus supplying abdominal wall

d) Discuss lymphatic drainage and nerves of abdomen , formation of cisterna chyli and thoracic duct

Interactive Lecture

16. Digestion & Absorption of Carbohydrates

a) Describe dietary carbohydrates and their action

Biochemistry Interactive Lecture

b) Explain the significance of the glycemic index

c) Describe the importance of dietary fibers

d) List the main digestive enzymes and describe their action on carbohydrate

e) Discuss the abnormalities due to digestive enzyme deficiency

f) Explain the absorption of monosaccharaides by the intestinal mucosal cells

g) Explain the significance of lactose intolerance

h) Perform serum glucose estimation (kit method) Practical

17.Digestion & Absorption of Proteins

a) List the various sources of dietary protein

Biochemistry

Interactive Lecture

b) Discuss the digestion of protein in the stomach and intestine

c) List and explain the function of the proteolytic enzymes

d) Explain the mechanism of absorption of amino acids

e) Discuss the biomedical importance of protein allergy, celiac sprue and cystinuria

f) Discuss the significance of amino acid pool

g) Explain the significance of nitrogen balance.

18.Digestion & Absorption of Lipid

a) List the constituents of dietary lipids

Biochemistry

Interactive Lecture b) List causes of steatorrhea

c) Discuss the digestion of lipid in the stomach and small intestine

d) Explain the role of lipases in lipid digestion


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e) Discuss the digestion of dietary cholesterol and phospholipid

Biochemistry

Interactive Lecture

f) Explain the hormonal regulation of lipid digestion

g) Discuss the absorption of lipid by the intestinal mucosal cells

h) Discuss the resynthesize and secretion of lipid by the enterocytes

i) Discuss the secretion of chylomicron by the enterocytes

j) Discuss the abnormalities of lipid digestion and absorption with especial reference to cystic fibrosis

k) Explain steatorrhoea

19. Glycolytic Pathway of Carbohydrates Metabolism

a) Differentiate between aerobic and anaerobic glycolysis

Biochemistry

Interactive Lecture

b) Explain the role of insulin in transport of glucose inside the cells

c) List the reactions of the two stages of glycolysis o Energy investment and o Energy generation

d) Explain the hormonal regulation of glycolysis

e) Discuss the fate of pyruvate

f) Explain the process of glycolysis in RBC’s

20. TCA Cycle of Carbohydrates Metabolism

a) Discuss the significance of TCA cycle as an amphibolic pathways

Biochemistry

Interactive Lecture b) Discuss the reactions of the TCA cycle and its regulatory steps

c) Describe the energy produced from TCA cycle

d) Explain the disorder of TCA cycle with special re ference to PDH deficiency

Interactive Lecture

21.Metabolism of Glycogen with Its Disorders

a) Explain the structure and function of glycogen


b) Describe the mechanism of glycogen synthesis and its regulation

c) Describe the mechanism of glycognenolysis and its regulation

d) Discuss the maintenance of blood glucose level


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e) Explain the various form of glycogen storage diseases

22. Metabolic Pathway of Gluconeogenesis

a) Describe the mechanism of gluconeogenesis


b) List the reactions which are unique to gluconeogenesis

c) Explain the mechanism of transport of oxaloacetic acid to the cytosol

d) Describe how gluconeogenesis is along with their regulatory enzymes

e) Explain the Cori cycle

23. Metabolic Pathway of HMP Shunt

a) Describe the significance of hexose monophosphate shunt


b) Describe the oxidative and non-oxidative stages of HMP shunt

c) Discuss the enzymes of the HMP shunt and its regulation.

d) Explain the abnormalities of the HMP shunt especially G6PD.

e) Discuss the significance of reactive oxygen species

f) Discuss the functions of NADPH and glutathione

24. Metabolic Pathway of Fructose & Galactose

a) List the sources of fructose


b) Discuss the alternative mechanism of monosaccharide metabolism

c) Discuss the important enzymes of fructose metabolism

d) Explain the metabolic pathway of fructose

e) Explain the disorders occur in fructose metabolism due to enzyme deficiencies

f) Discuss the important enzymes of in Galactose metabolism

g) Explain the metabolic pathway of Galactose metabolism

h) Explain the disorders occur in Galactose metabolism due to enzyme deficiencies

i) Describe the importance of uronic acid pathway in liver detoxification


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25. Bioenergetics & Biological Oxidation

a) List high energy and low energy phosphate


b) List the oxido-reductase enzyme

c) Define bioenergetics and explain the general laws of thermodynamics

d) Define free energy and equilibrium constant

e) Describe the coupling of endergonic and exergonic reactions by high energy intermediate (e.g. ATP)

f) Describe the role of ATP as a energy carrier

g) Describe biologic oxidation and redox potential

26. Oxidative Phosphorylation & Electron Transport Chain

a) List the ion transporters in the inner mitochondrial membranes


b) List the genetic defects of oxidative phosphorylation

c) Explain the energy currency of the body

d) Explain the site and mechanism of synthesis of ATP

e) Describe the organization of the electron transport chain

f) Discuss the functions of each complex of ETC

g) Describe how proton are pumped from the matrix to the intermembrane space

h) Discuss the significance of co-enzyme Q and the Q-cycle

i) Discuss the inhibitors and uncouplers of ETC and their mechanism of action

j) Discuss how electron transport chain releases free energy

k) Discuss the generation of proton gradient

l) Explain the significance of P.O. Ratio

m) Explain Mitchell’s chemiosmosis theory of electrochemical gradient

n) Explain the glycerophosphate and malate shuttle

27. Metabolic Role of Liver & Its Detoxification

a) List the liver function tests based on the five main functions of the liver

Biochemistry

Interactive Lecture

b) Discuss the metabolic, synthetic, excretory, detoxification and storage functions of liver


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c) Explain the normal level of serum bilirubin (total, conjugated and unconjugated), urinary urobilinogen, urinary bilirubin, fecal stercobilinogen in different types of Jaundice

Biochemistry

Interactive Lecture

d) Discuss the importance of serum enzyme in the differential diagnosis of Jaundice (ALT, AST, ALP, LDH, GGT, and 5’-Nucleotidase)

e) Discuss the importance of albumin, total protein and prothrombin time in diagnosing liver disease

28. Degradation of Hemoglobin and Bilirubin Metabolism

a) List the steps of heme degradation to bilirubin


b) Discuss the role of liver in bilirubin uptake and conjugation

c) Discuss the secretion of bilirubin in bile

d) Explain the fate of bilirubin in the intestine and its excretion in urine and stool

29. Jaundice and its biochemical investigations

a) Describe the disorders of bilirubin metabolism

Biochemistry

Interactive Lecture

b) Explain the types of bilirubin in the blood

c) Discuss jaundice

d) Explain the causes and diagnostic investigations of pre-hepatic Jaundice

e) Explain the causes and diagnostic investigations of hepatocellular Jaundice

f) Explain the causes and diagnostic investigations of post-hepatic and obstructive Jaundice

g) Demonstrate LFTs, serum aminotransferase and serum bilirubin in lab

Practical

30. Growth assessment and malnutrition

a) Describe the importance and uses of growth chart

Community Medicine

Interactive Lecture b) Describe the methods of assessment of nutritional status and interpret the growth chart

c) Define malnutrition

Interactive Lecture d) Classify malnutrition

e) Discuss control measures and prevention of malnutrition

31. Medical Entomology and Parasitology

a) Define entomology Community Medicine

Interactive Lecture b) Classify entomology


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c) Describe diseases caused by winged and wingless insects

Community

Medicine

Interactive Lecture d) Classify parasites

e) Describe role of parasites in spread of disease

f) Discuss control measures and prevention of

g) common parasitic diseases

32. Substance abuse and alcoholism

a) Explain risk factors, effects and control measures for substance abuse and alcoholism Community

Medicine Interactive Lecture

b) Discuss situation analysis of Pakistan regarding substance abuse and alcoholism


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LEARNING RESOURCES

SUBJECT RESOURCES

ANATOMY

A. GROSS ANATOMY 1. K.L. Moore, Clinically Oriented Anatomy 2. Neuro Anatomy by Richard Snell

B. HISTOLOGY 1. B. Young J. W. Health Wheather’s Functional Histology

C. EMBRYOLOGY 1. Keith L. Moore. The Developing Human 2. Langman’s Medical Embryology

BIOCHEMISTRY

A. TEXTBOOKS 1. Harper’s Illustrated Biochemistry 2. Lehninger Principle of Biochemistry 3. Biochemistry by Devlin

COMMUNITY MEDICINE

A. TEXT BOOKS 1. Community Medicine by Parikh 2. Community Medicine by M Illyas 3. Basic Statistics for the Health Sciences by Jan W Kuzma

PATHOLOGY/MICROBIOLOGY

A. TEXT BOOKS 1. Robbins & Cotran, Pathologic Basis of Disease, 9th edition. 2. Rapid Review Pathology, 4th edition by Edward F. Goljan MD

1. http://library.med.utah.edu/WebPath/webpath.html 2. http://www.pathologyatlas.ro/

PHARMACOLOGY

A. TEXT BOOKS 1. Lippincot Illustrated Pharmacology 2. Basic and Clinical Pharmacology by Katzung

PHYSIOLOGY

A. TEXTBOOKS 1. Textbook Of Medical Physiology by Guyton And Hall 2. Ganong ‘ S Review of Medical Physiology 3. Human Physiology by Lauralee Sherwood 4. Berne & Levy Physiology 5. Best & Taylor Physiological Basis of Medical Practice

B. REFERENCE BOOKS 1. Guyton & Hall Physiological Review 2. Essentials Of Medical Physiology by Jaypee 3. Textbook Of Medical Physiology by InduKhurana 4. Short Textbook Of Physiology by Mrthur 5. NMS Physiology

http://www.amazon.com/s/ref=dp_byline_sr_book_1?ie=UTF8&field-author=Edward+F.+Goljan+MD&search-alias=books&text=Edward+F.+Goljan+MD&sort=relevancerank

http://www.amazon.com/s/ref=dp_byline_sr_book_1?ie=UTF8&field-author=Edward+F.+Goljan+MD&search-alias=books&text=Edward+F.+Goljan+MD&sort=relevancerank

http://library.med.utah.edu/WebPath/webpath.html

http://library.med.utah.edu/WebPath/webpath.html

http://www.pathologyatlas.ro/

http://www.pathologyatlas.ro/


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OTHER LEARNING RESOURCES

Hands-on Activities/ Practical Students will be involved in Practical sessions and hands-on activities that link with the GIT & Liver-I module to enhance the learning.

Labs Utilize the lab to relate the knowledge to the specimens and models

available.

Skills Lab A skills lab provides the simulated learning experience to learn the basic

skills and procedures. This helps build the confidence to approach the

patients.

Videos

Video familiarize the student with the procedures and protocols to assist

patients.

Computer

Lab/CDs/DVDs/Internet

Resources:

To increase the knowledge students should utilize the available internet

resources and CDs/DVDs. This will be an additional advantage to increase

learning.

Self Learning

Self Learning is scheduled to search for information to solve cases, read

through different resources and discuss among the peers and with the

faculty to clarify the concepts.


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ASSESSMENT METHODS:

Theory:

o Best Choice Questions (BCQs) also known as MCQs (Multiple Choice Questions) are used to assess

objectives covered in each module.

• A BCQ has a statement or clinical scenario followed by four options (likely answer).

• Students after reading the statement/scenario select ONE, the most appropriate response

from the given list of options.

• Correct answer carries one mark, and incorrect ‘zero mark’. There is no negative marking.

• Students mark their responses on specified computer-based/OMR sheet designed for LNHMC.

OSPE/OSCE: Objective Structured Practical/Clinical Examination:

• Each student will be assessed on the same content and have same time to complete the task.

• Comprise of 12-25 stations.

• Each station may assess a variety of clinical tasks, these tasks may include history taking, physical examination, skills and application of skills and knowledge

• Stations are observed, unobserved, interactive and rest stations.

• Observed and interactive stations will be assessed by internal or external examiners.

• Unobserved will be static stations in which there may be an X-ray, Labs reports, pictures, clinical

scenarios with related questions for students to answer.

• Rest station is a station where there is no task given and in this time student can organize

his/her thoughts.

Internal Evaluation

• Students will be assessed to determine achievement of module objectives through the following:

o Module Examination: will be scheduled on completion of each module. The method of

examination comprises theory exam which includes BCQs and OSPE (Objective Structured Practical

Examination).

o Graded Assessment of students by Individual Department: Quiz, viva, practical, assignment, small

group activities such as CBL, TBL, TOL, online assessment, ward activities, examination, and log

book.

• Marks of both modular examination and graded assessment will constitute 20% weightage.

• As per JSMU policy, this 20% will be added by JSMU to Semester Examination.


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Example : Number of Marks allocated for Semester Theory and Internal Evaluation

Semester

Semester Examination Theory Marks

Internal Evaluation (Class test + Assignments

+ Modular Exam)

Total (Theory)

80% 20% 100%

Formative Assessment

• Individual department may hold quiz or short answer questions to help students assess their

own learning. The marks obtained are not included in the internal evaluation

More than 75% attendance is needed

to sit for the modular and semester

examinations


2019 Page | 24

MODULAR EXAMINATION RULES & REGULATIONS (LNH&MC)

• Student must report to examination hall/venue, 30 minutes before the exam.

• Exam will begin sharp at the given time.

• No student will be allowed to enter the examination hall after 15 minutes of scheduled

examination time.

• Students must sit according to their roll numbers mentioned on the seats.

• Cell phones are strictly not allowed in examination hall.

• If any student is found with cell phone in any mode (silent, switched off or on) he/she will be not

be allowed to continue their exam.

• No students will be allowed to sit in exam without University Admit Card, LNMC ID Card and Lab

Coat

• Student must bring the following stationary items for the exam: Pen, Pencil, Eraser, and

Sharpener.

• Indiscipline in the exam hall/venue is not acceptable. Students must not possess any written

material or communicate with their fellow students.

JSMU Grading System

• It will be based on GPA – 4 system

Marks obtained in Percentage range

Numerical Grade

Alphabetical Grade

80-100 4.0 A+

75-79 4.0 A

70-74 3.7 A-

67-69 3.3 B+

63-66 3.0 B

60-62 2.7 B-

56-59 2.3 C+

50-55 2.0 C

<50 Un-grade-able 0 U

• A candidate obtaining GPA less than 2.00 (50%) is declared un-graded (fail).

• Cumulative transcript is issued at the end of clearance of all modules.


2019 Page | 25

SCHEDULE:

WEEKS 2nd YEAR SEMESTER 4 MONTH

WEEK 1

GIT & LIVER MODULE-I

1st April 2019 WEEK 2

WEEK 3 WEEK 4 WEEK 5 WEEK 6 14th May 2019

MODULAR EXAM 17th & 18th May 2019* WEEK 1

REPRODUCTIVE SYSTEM MODULE-I

20th May 2019* WEEK 2 WEEK 3 WEEK 4 13th June 2019*

MODULAR EXAM 14th & 15th June 2019*

WEEK 1 RENAL & EXCRETORY SYSTEM

MODULE-I

17th June 2019* WEEK 2 WEEK 3 WEEK 4 11th July 2019*

MODULAR EXAM 12th & 13th July 2019*

PREPARATORY LEAVE

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